Antineoplastic drugs surface contamination inside a healthcare service

Atgé B1,2,3, Léger C2, Da Silva Caçao O1, Verdun-Esquer C2,4, Molimard M1, Villa A5, Canal-Raffin M1,2,4
1 Laboratoire de Pharmacologie Clinique et de Toxicologie, CHU Bordeaux, France
2 Service de Santé Travail Environnement, CHU de Bordeaux, France
3 AHI33, Service de Santé au Travail, Bordeaux, France
4 INSERM U1219, équipe EPICENE, Université de Bordeaux, France
5 Consultation de pathologie professionnelle, Hôpital la Timone (Aphm), Marseille, France

Context – objective
Cancers treatment involve drugs classified as « dangerous to handle » leading to health risks to exposed workers. Staff contamination occurs mainly by the dermal route, directly by contact with antineoplastic drugs (AD) or treated patients, or indirectly by contact with contaminated work surfaces. The objective was to assess surfaces contamination inside a healthcare service whose alarming internal contamination rate (>80%) of nurses.

Method
A surface sampling kit associated to high sensible analytic method (UHPLC-MS/MS) developed by the CHU of Bordeaux, were used to identify and quantify 15 AD. Sampling zones were selected by analysing AD life cycle within healthcare service.

Results
In total, 100% of samples (n=24) showed the presence of at least one AD, with mainly detection of methotrexate (91.6%, n=22/24), ifosfamide (91.6%, n=22/24) and cyclophosphamide (83.3%, n=20/24). Inside treated patients rooms (n=9), concentration levels (all AD considered) were from 1pg/cm2 to 1ng/cm2. These levels are 10 to 104 more concentrated compared to others studied zones (p<0.001; Student). On electronic devices (n=4), service reception (n=2) and break room (n=2), concentrations were from 1 to 100pg/cm2. Lowest concentrations were founded in healthcare rooms on benches (n=7) with values from 0.1 to 1pg/cm2.

Discussion – Conclusion
Results showed that inside healthcare services, AD contamination level in the areas close to AD bags was lower compared to direct environment (patient rooms) of treated patients. This could be explained by a higher cleaning frequency of work surfaces in healthcare rooms and/or by the utilisation of others detergents types and/or by a better workers vigilance about AD contamination risk during manipulation. Moreover, the lack of knowledge about environmental contamination risk from the treated patient via its excreta (urine, sweat, vomit) could explain the high levels of AD concentration in patient rooms. Indeed, within healthcare services, except AD themselves, patients are the main source of contamination and they can continue to contaminate the environment following days after AD administration. Correction measures will be implemented regarding to the cleaning process in patient rooms, which is currently insufficient. Otherwise, a reflexion will be lead about patient role into contamination prevention around his environment.

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